By Margaret Kalekye/PSCU
Beyond Zero Mobile clinic in West Pokot has been described as the greatest opportunity in the County’s health care delivery system.
Both the political leaders and health professionals in West Pokot have accepted the mobile clinic as a key component in the County’s critical health care delivery system where it serves both as a mobile hospital, ambulance and communication nerve centre for the six ambulances serving the region especially when patients need emergency evacuation.
According to the Nursing Officer in-charge of Kapenguria County Referral Hospital Ms Rhoda Lodia, the mobile clinic is linked through telephones to all the six ambulances serving the county and majority health facilities in West Pokot
The clinic is also linked to the referral hospital at Kapenguria where patients that need further assistance and emergency care that cannot be handled by the clinic are referred.
Most of the outreach missions by the mobile clinic are however conducted in Pokot Central and Pokot North Sub-Counties , both of which border Turkana, a region associated with perennial insecurity and long distances between health centres and dispensaries.
According to the West Pokot County Director of Health Dr. Nobert Abuya, insecurity along this border over the years has left the region seriously marginalized in terms of development.
The two sub-counties have the least development including schools , health centres and other critical physical infrastructure.
“There is not growth in this region due to prolonged incidences of insecurity”, says Dr Abuya adding that the migratory nature of the nomadic pastoralists that inhabit the region fits well with the mobile clinic because it can follow them wherever they go.
“The clinic moves with them for continuous services”, says the Director adding that the mobile clinic van can only access the pastoralists in areas where there are accessible roads.
“And there are no roads to talk about in this region. We cannot serve populations where there are no roads”, he adds.
While on this outreach missions, it is the staff operating the facility that form the communication linkages with Ms Lodia where the ambulances are needed and which health facilities are nearest to the patient.
“The Beyond Zero team either calls the hospital (Kapenguria County Referral Hospital) or writes the referrals. But when no ambulance is available, the clinic rushes the patient to the nearest health facility after first stabilizing the patient”, says Mrs Lodia.
Another unique aspect of the Mobile Clinic in West Pokot is that it does not have any permanent staff. Through proper organization and scheduling, the Clinic is able to draw its staff from the catchment area wherever it holds its outreach missions.
“It (mobile Clinic) is usually manned by health professionals from respective (nearby) dispensaries and hospitals where it is operating from “, Adds Ms Lodia.
And because West Pokot County borders Uganda to the West, Ugandans are some of the beneficiaries of the clinic whenever it conducts its outreach missions along the Kenyan/Uganda border populations.
Some of the Ugandans are even referred to Kapenguria County Referral Hospital according Ms Lodia
Despite the huge challenges , interventions provided through the clinic , in collaboration with other partners have significantly improved health indicators in the 9169.4 square km County including some of its hardest to reach sub-counties.
Some of the improved health indicators include improved skilled deliveries from 20 to 48 per cent , Child immunization from 43-65 per cent, ante-natal services at 48 and a 14 per cent contraceptive prevalence .
But insecurity is a key determinant of the successful operations of the mobile clinic.
When the PSCU team traced the mobile clinic at Amarer region in Pokot Central Sub-County, some 125 km from Kapenguria and 55 km from Sigor trading centre, we established that the Mobile clinic was initially scheduled to hold the outreach mission at Akulo area but a cattle rustling incident in the centre forced change of plans for the outreach.
And even as the outreach mission was ongoing at Amarer, there was a parallel peace meeting between members of the Pokot community and those from Turkana negotiating how the stolen animals could be repatriated through a peaceful mechanism.
Despite the incident, the outreach mission went ahead as planned and patients, mainly women and children were able to receive critical services.
Services provided through the clinic include Family Planning, HIV testing, Out-patient curative services, immunization, Prevention of Mother To Child (HIV) Transmission (PMTCT) services, Maternal Child Health (MCH) services, Health Education, Nutrition Services and distribution of mosquito nets.
Mrs Cheporwala Longole, a 28-year old mother of four and who had attended her second ante-natal clinic for her fifth pregnancy said she was happy for the services offered by the clinic.
“There is no hospital nearby. The clinic should continue coming here every month”, said Mrs Longole through an interpreter. She had travelled more than 5 km from Kolosia Village to attend the ANC clinic. Her husband was away for the previous two weeks tending to their animals.
“He comes every two weeks to see the children depending on security in the area”, she added.
Traditional Birth attendant Mrs Margaret Puorok, a mother of 10 and expecting her 11th child said the mobile clinic is a great assistance to both the Pokot and Turkana communities whenever there is peace.
She assists pregnant mothers deliver their babies before referring them to the nearest health facility. Sigor Level 4 hospital is 55 km from Amarer but there is a nearby dispensary several km away. The beyond Zero clinic is a godsend according to Mrs Puorok
Due to insecurity in the Akulo/ Amarer regions and heightened anxiety due to the cattle-rustling raid, the local chairman-cum-elder for peace, Pauko Korwa from Akulo had to accompany the women and children seeking services at the clinic.
“This clinic greatly assists the women and children. The men only come to the clinic when they are too sick”, he adds.
Since the First Lady launched the clinic in West Pokot on June 10, 2015, it has directly provided health services to 28,740 people mainly from Pokot North and Pokot Central sub-counties.
According to the Pokot Central Sub-County Public Health Nurse Stephen Porriot under whose management the mobile clinic falls, the people who have received its services included 4657 children under 5 years and 1006 others under one year—all of whom may have never had a chance for any medical intervention for their various ailments.
Besides insecurity, other key challenges facing the Pokot people include persistent famine, poor road network and poor terrain, a nomadic pastoralism lifestyle where the communities are always on the move and socio-cultural problems associated with FGM, early marriages and polygamy.
Other challenges in the County that hinder equity in provision of health services include long distances between existing facilities, low literacy levels and the role of Traditional Birth Attendants who are culturally accepted as “doctors” in midwifery.
Malnutrition and acute stunting standing at 45 per cent are also major health challenges in West Pokot although both issues are economic/food related matters rather than health.